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P Herve, JY Cahn, M Flesch, E Plouvier, E Racadot, A Noir, Y Couteret, G Goldstein, A Bernard and R Lenys
Thirty-two patients with acute leukemia, chronic granulocytic leukemia, or
multiple myeloma received a T lymphocyte-depleted HLA-identical marrow.
After being treated with pan-T monoclonal antibodies (MoAbs) and one round
of baby rabbit complement, the mean percentage of T cell depletion was 94%
+/- 4%. The number of residual viable T cell infused to the patient was
0.99 +/- 0.65 X 10(6) per kg body weight. The patients were conditioned
with fractionated total body irradiation (TBI) (12 Gy) preceding high doses
of cyclophosphamide (120 mg/kg). Methotrexate was used as an additional
immunosuppressant in the first ten patients. For the following 22 patients
no posttransplant immunoprophylaxis was administered. Eight patients died
within three months due to complications related to transplantation.
Engraftment was achieved in all evaluable patients, and no patient has a
late graft failure. The proof of total chimerism was established in 24
patients. Twenty-four of 27 evaluable patients (88%) did not have an acute
graft- v-host disease (GVHD) greater than grade 0 to 1. Two patients had a
grade 2 (skin only), and one patient had a grade 4 acute GVHD (the latter
had only 80% of T cell depletion). A medullary relapse occurred in 11
patients (nine of them had previously been defined as "high risk
leukemia"). Our data suggest that it may not be necessary to deplete nearly
all T cells to prevent acute GVHD in recipients of HLA-identical marrow.
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| Copyright © 1987 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||